Prevalence and Risk Factors of Hypertension among Government Employees Serving in Rangpur City, Bangladesh

Hypertension (HTN) is an important cause of cardiovascular mortality and the prevalence of hypertension is increasing particularly in middle- and low-income countries including Bangladesh. No data are available for the prevalence of hypertension among the government employees in Bangladesh. In this cross-sectional study, conducted from 30 October to 31 December 2016, 1219 government employees aging ≥18 years working in Rangpur city were evaluated for the presence of HTN and its risk factors. Socio-demographic and anthropometric data, data on the presence of various known risk factors of hypertension were collected. Hypertension was defined with systolic BP ≥140mmHg and/or diastolic BP ≥90mmHg or those getting treatment for hypertension. Statistical analysis was done by using SPSS version 23.0; odds of hypertension among subjects with risk factors were calculated and p ≤0.05 was considered to be statistically significant. The prevalence of hypertension was 38.3% among the study subjects. Significantly higher odds of having hypertension were observed in study subjects with the age groups of 35-49 (OR 2.12, 95% CI: 1.51-2.99, p<0.001) and ≥50 (OR: 4.96, 95% CI: 3.43-7.18, p<0.001) years than age group <35 years. Employees who were averagely satisfied and not satisfied for their jobs also had higher odds (OR: 1.38, 95% CI: 1.00-1.91, p=0.049 and OR: 1.48, 95% CI: 3.43-7.18, p=0.337) of having hypertension than fully satisfied ones. Having diabetes mellitus was found to increase the odds (OR 2.12, 95% CI: 1.51-2.99, p<0.001) of hypertension. Male gender, urban/suburban residence, not doing physical exercise, sedentary/light working habit, overweight/obesity also increased the odds of having hypertension though these were not statistically significant. There is a high burden of hypertension among the government employees in Rangpur city. Age, job satisfaction and diabetes were independent risk factors of hypertension.

Enhanced responsivity resonant RF photodetectors

The responsivity of room-temperature, semiconductor-based photodetectors consisting of resonant RF circuits coupled to microstrip buslines is investigated. The dependence of the photodetector response on the semiconductor material and RF circuit geometry is presented, as is the detector response as a function of the spatial position of the incident light. We demonstrate significant improvement in detector response by choice of photoconductive material, and for a given material, by positioning our optical signal to overlap with positions of RF field enhancement. Design of RF circuits with strong field enhancement are demonstrated to further improve detector response. The improved detector response demonstrated offers opportunities for applications in RF photonics, materials metrology, or single read-out multiplexed detector arrays.

Microfluidic fabrication of cationic curcumin nanoparticles as an anti-cancer agent

Curcumin nanoparticles of less than 50 nm in diameter are accessible using a continuous flow microfluidic rotating tube processor (RTP) under scalable conditions, at room temperature. A mixture of DDAB and Pluronic F127 renders higher stability of the curcumin nanoparticles in physiological pH 7.4 for up to eight hours. The nanoparticles have enhanced cytotoxicity in estrogens receptor negative and positive breast cancer cell lines compared with free curcumin.

Nanosized drug formulations under microfluidic continuous flow

We present a simple method involving a rotating tube processor to fabricate ultrafine crystalline drug nanoparticles under microfluidic continuous flow with precise control over particle size, with significantly enhanced dissolution of the drug.

An unusual case of carotid dissection

Carotid dissection is a rare, but potentially fatal, cause of ischaemic stroke in young patients. It occurs when a small tear forms in the tunica intima of the arterial wall creating a space between the inner and outer layers of the vessel where blood can enter and form a haematoma. This can cause a stenosis or complete occlusion. Thromboembolic events are thought to be the cause of infarction in the majority of cases of stroke, rather than haemodynamic insufficiency, in patients with carotid dissection. Although traditionally thought to be most commonly caused by head or neck trauma, spontaneous carotid dissection is now an increasingly recognised cause of stroke in young patients. Clinical signs can often be subtle, with mild cerebral or cranial nerve dysfunction. Here, a case is reported of a spontaneous internal carotid artery dissection in a previously well 38-year-old man. An appropriate imaging modality is important to confirm the diagnosis before commencing anticoagulation treatment.

Intra-individual variation of serum prostate specific antigen levels in men with benign prostate biopsies

OBJECTIVE

To determine the intra-individual (physiological) variation of prostate-specific antigen (PSA) measurements in men after a benign prostatic biopsy.

PATIENTS AND METHODS

Sixty-four men were prospectively assessed, all of whom had a benign prostatic biopsy within the preceding 13 months. The degree of intra-individual variability was established by calculating the coefficient of variation on four PSA levels obtained from each patient weekly over a month.

RESULTS

Six patients were subsequently diagnosed with prostate cancer and their data are presented separately. In the remaining 58 patients the median (range) individual mean PSA value was 6.3 (0.5-34.1) ng/mL. The median (range) coefficient of variation within the group was 9.5 (2.4-76.1)%. There was a clear linear relationship between mean PSA level and the standard deviation.

CONCLUSION

In 48 of the 63 patients analysed, the coefficient of variation for serum PSA values in the group as a whole was greater than the variation claimed for the assay technique. The significance of the linear relationship between PSA and the standard deviation is discussed, with particular reference to those men who had a benign prostate biopsy.

PHYSICIAN-PATIENT COMMUNICATION REGARDING PRESCRIBED MEDICATION IN AN AMBULATORY CARE SETTING IN KATHMANDU, NEPAL

Physician-patient interactions often lead to prescription of medicines. Safety andcompliance in the use of these medicines are largely dependent on proper verbal aswell as written communication between prescriber and patient. However, severalpublished reports suggest that such communication is often inadequate. The presentstudy indicated suboptimal doctor-patient communication at a tertiary care hospitalin Nepal. Fifty-two (21.7%) of the 240 patients/caregivers interviewed after out-patientconsultation claimed that doctors did not provide any information on prescribedmedicines. Nearly a quarter of the 188 patients/caregivers who did report havingreceived information could not recall what they had been told, and in more than halfof these cases the lack of recall was attributed to problems in communication. Frequentuse of the English language and Latin abbreviation in prescribed dosing schedulesindicated a need for improvement in written communication as well.Key Words: prescribing information; communication; physician-patient interaction; Nepal.

Retinopathy progression and visual outcomes after phacoemulsification in patients with diabetes mellitus

OBJECTIVES

To determine the rate of progression of diabetic retinopathy after phacoemulsification surgery, and whether surgeon experience and/or surgical duration adversely affect visual outcome.

METHODS

A retrospective review of 150 eyes of 119 diabetic patients who underwent phacoemulsification surgery during a 5-year period was performed. Data collected included patient age, sex, type and duration of diabetes, diabetic control, associated systemic health factors, preoperative visual acuity and retinopathy grade, duration of surgery, intraoperative complications, and postoperative course. The effect of these factors on visual outcome and rate of retinopathy progression was studied by means of univariate and stepwise multivariate logistic regression analyses. Resident and private cases were compared.

RESULTS

Visual acuity improved by 2 or more lines in 117 eyes (78%); 93 eyes (62%) had a final visual acuity of at least 20/40. Retinopathy progression was seen in 37 eyes (25%) with 6 to 10 months of follow-up. Preoperative nonproliferative diabetic retinopathy, proliferative diabetic retinopathy, and limited surgical experience were statistically associated with retinopathy progression and poor visual outcome.

CONCLUSIONS

The visual results and rate of retinopathy progression after phacoemulsification surgery in our series did not differ significantly from those reported that used other techniques. Nonproliferative and proliferative diabetic retinopathy and surgical inexperience resulted in an increased rate of retinopathy progression. Arch Ophthalmol. 2000;118:912-917

Retinopathy progression and visual outcomes after phacoemulsification in patients with diabetes mellitus

OBJECTIVES

To determine the rate of progression of diabetic retinopathy after phacoemulsification surgery, and whether surgeon experience and/or surgical duration adversely affect visual outcome.

METHODS

A retrospective review of 150 eyes of 119 diabetic patients who underwent phacoemulsification surgery during a 5-year period was performed. Data collected included patient age, sex, type and duration of diabetes, diabetic control, associated systemic health factors, preoperative visual acuity and retinopathy grade, duration of surgery, intraoperative complications, and postoperative course. The effect of these factors on visual outcome and rate of retinopathy progression was studied by means of univariate and stepwise multivariate logistic regression analyses. Resident and private cases were compared.

RESULTS

Visual acuity improved by 2 or more lines in 117 eyes (78%); 93 eyes (62%) had a final visual acuity of at least 20/40. Retinopathy progression was seen in 37 eyes (25%) with 6 to 10 months of follow-up. Preoperative nonproliferative diabetic retinopathy, proliferative diabetic retinopathy, and limited surgical experience were statistically associated with retinopathy progression and poor visual outcome.

CONCLUSIONS

The visual results and rate of retinopathy progression after phacoemulsification surgery in our series did not differ significantly from those reported that used other techniques. Nonproliferative and proliferative diabetic retinopathy and surgical inexperience resulted in an increased rate of retinopathy progression. Arch Ophthalmol. 2000;118:912-917

A combination light-pipe, soft-tipped suction, and infusion cannula instrument for macular translocation

PURPOSE

To describe a combination light-pipe, soft-tipped suction needle, and infusion cannula instrument for use in macular translocation surgery.

METHODS

Macular translocation surgery was performed in human cadaver and live rabbit eyes with a combination light-pipe, soft-tipped suction needle, and infusion cannula instrument.

RESULTS

A combination light-pipe, soft-tipped suction needle, and infusion cannula can be used for macular translocation. This instrument is useful for relocating the retina after a 360 peripheral retinotomy is created. It can also be used for macular translocation with the scleral imbrication technique when superior movement of the fovea is required. When used in combination with another soft-tipped suction needle instrument, this surgical instrument allows precise bimanual placement of the retina with simultaneous infusion of liquid perfluorocarbon for fixating the macula to its new location.

CONCLUSION

A combination light-pipe, soft-tipped suction needle, and infusion cannula instrument may be a useful tool for macular translocation surgery.

The use of topical aqueous suppressants in the prevention of postoperative intraocular pressure elevation after pars plana vitrectomy with long-acting gas tamponade

OBJECTIVE

To determine whether topical aqueous suppressant therapy applied after pars plana vitrectomy with gas tamponade prevents postoperative intraocular pressure (IOP) elevation.

DESIGN

Prospective, nonrandomized comparative study.

PARTICIPANTS

Forty-one patients who met inclusion criteria and underwent pars plana vitrectomy with gas tamponade (SF6 18%-20% or C3F8 12%-16%) over a 1-year period.

INTERVENTION

Treatment eyes received topical aqueous suppressants at the end of surgery.

MAIN OUTCOME MEASURES

Postoperative IOP at 4 to 6 hours, 1 day, and 1 week.

RESULTS

Twenty-one control and 20 treatment eyes met the inclusion criteria. The IOP (in mmHg) measured at 4 to 6 hours (23.05 [control, 14.73 [treatment]) and 1 day (23.24 [control], 17.28 [treatment]) postoperatively showed a statistically significant difference between the groups (P = 0.0038) at 4 to 6 hours and a trend toward significance (P = 0.057) at 1 day. Eleven control and three treatment eyes had an IOP spike above 25 mmHg at 4 to 6 hours or 1 day postoperatively (P = 0.02), and six control eyes and one treatment eye had postoperative IOP greater than 30 mmHg. A pressure rise greater than 40 mmHg was seen in two control eyes and no treatment eyes.

CONCLUSIONS

Use of topical aqueous suppressants after pars plana vitrectomy with long-acting gas tamponade is effective in preventing significant postoperative IOP elevation in most cases.

The development of choroidal neovascularization in pregnancy

PURPOSE

To evaluate the possible association between the development of choroidal neovascularization (CNV) and pregnancy.

METHODS

A retrospective review was performed of the clinical records of three patients who were pregnant at the time a choroidal neovascular membrane (CNVM) was diagnosed. The clinical presentations and treatment of the CNVM occurring in association with the pregnancies are described.

RESULTS

Each patient had a decrease in visual acuity during her pregnancy: one in the first trimester, one in the second trimester, and one in the third trimester. Two patients were diagnosed with CNV related to presumed ocular histoplasmosis syndrome (POHS) and one with an idiopathic CNVM. The two-patients with POHS showed progression of CNV after childbirth. All patients received laser photocoagulation directly to the site of the CNV. The two patients with ocular histoplasmosis experienced recurrence after treatment; one received further photocoagulation treatment, and the other underwent vitrectomy with removal of the CNVM.

CONCLUSIONS

Pregnancy and the immediate postpartum period may be associated with development or recurrence of CNV in POHS or idiopathic cases. This may be related to hormonal changes during pregnancy, or the cases described may reflect only a coincidental association. This report discusses possible causal factors and mechanisms.

Ancient-modern concordance in Ayurvedic plants: some examples

Ayurveda is the ancient (before 2500 b.c.) Indian system of health care and longevity. It involves a holistic view of man, his health, and illness. Ayurvedic treatment of a disease consists of salubrious use of drugs, diets, and certain practices. Medicinal preparations are invariably complex mixtures, based mostly on plant products. Around 1,250 plants are currently used in various Ayurvedic preparations. Many Indian medicinal plants have come under scientific scrutiny since the middle of the nineteenth century, although in a sporadic fashion. The first significant contribution from Ayurvedic materia medica came with the isolation of the hypertensive alkaloid from the sarpagandha plant (Rouwolfia serpentina), valued in Ayurveda for the treatment of hypertension, insomnia, and insanity. This was the first important ancient-modern concordance in Ayurvedic plants. With the gradual coming of age of chemistry and biology, disciplines central to the study of biologic activities of natural products, many Ayurvedic plants have been reinvestigated. Our work on Commiphora wightti gum-resin, valued in Ayurveda for correcting lipid disorders, has been described in some detail; based on these investigations, a modern antihyperlipoproteinemic drug is on the market in India and some other countries. There has also been concordance for a few other Ayurvedic crude drugs such as Asparagus racemosus, Cedrus deodara, and Psoralea corylifolia.

Ancient-modern concordance in Ayurvedic plants: some examples

Ayurveda is the ancient (before 2500 b.c.) Indian system of health care and longevity. It involves a holistic view of man, his health, and illness. Ayurvedic treatment of a disease consists of salubrious use of drugs, diets, and certain practices. Medicinal preparations are invariably complex mixtures, based mostly on plant products. Around 1,250 plants are currently used in various Ayurvedic preparations. Many Indian medicinal plants have come under scientific scrutiny since the middle of the nineteenth century, although in a sporadic fashion. The first significant contribution from Ayurvedic materia medica came with the isolation of the hypertensive alkaloid from the sarpagandha plant (Rouwolfia serpentina), valued in Ayurveda for the treatment of hypertension, insomnia, and insanity. This was the first important ancient-modern concordance in Ayurvedic plants. With the gradual coming of age of chemistry and biology, disciplines central to the study of biologic activities of natural products, many Ayurvedic plants have been reinvestigated. Our work on Commiphora wightti gum-resin, valued in Ayurveda for correcting lipid disorders, has been described in some detail; based on these investigations, a modern antihyperlipoproteinemic drug is on the market in India and some other countries. There has also been concordance for a few other Ayurvedic crude drugs such as Asparagus racemosus, Cedrus deodara, and Psoralea corylifolia.

Visual outcomes after pars plana vitrectomy for epiretinal membranes associated with pars planitis

OBJECTIVE

To evaluate the results of pars plana vitrectomy and membrane stripping for visually significant macular epiretinal membranes associated with chronic idiopathic pars planitis.

DESIGN

Consecutive noncomparative case series.

PARTICIPANTS AND METHODS

The records of all patients who underwent pars plana vitrectomy for pars planitis from 1988 through 1997 were retrospectively reviewed. Seven eyes of five patients who were diagnosed with visually significant epiretinal membranes associated with pars planitis and who underwent vitrectomy and membrane stripping were analyzed. Patients were diagnosed with pars planitis based on characteristic clinical signs and pertinent negative laboratory test results.

INTERVENTION

Pars plana vitrectomy and epiretinal membrane stripping.

MAIN OUTCOME MEASURES

Visual acuity and inflammatory grade were compared between the last preoperative visit and the most recent follow-up visit. Intraoperative and postoperative complications were also analyzed.

RESULTS

The mean patient age was 31 years (range, 6 to 45 years). The mean duration of uveitis was 6.4 years (range, 6 months to 13 years). All patients were treated with combinations of periocular, topical, and oral corticosteroids before surgery. Five eyes had laser retinopexy, and two eyes had cryopexy to the inferior retina at the time of surgery. Five eyes had at least 3 Snellen lines of visual acuity improvement, and visual acuity in one eye worsened by 2 lines. Mean preoperative visual acuity was 20/73 (range, 20/50 to 20/300), and mean final visual acuity was 20/37 (range, 20/25 to 20/70). Five eyes had a final visual acuity of 20/40. Vitritis improved in all cases. Mean follow-up was 23 months (range, 3 to 54 months). Six of seven eyes had progressive cataract development, four of which underwent cataract extraction. No other intraoperative or postoperative complications occurred.

CONCLUSIONS

Removal of epiretinal membranes associated with pars planitis can be safely performed and may result in improved visual acuity. Patients often require subsequent cataract extraction to obtain the best long-term final acuity.

Progression of diabetic retinopathy after endophthalmitis

OBJECTIVE

To determine the effect of endophthalmitis on diabetic retinopathy.

DESIGN

Noncomparative case series.

METHODS

The records of all consecutive patients with endophthalmitis treated between 1992 and 1997 at the Medical College of Wisconsin were retrospectively reviewed. Those patients with diabetes mellitus were analyzed.

PARTICIPANTS

From 77 reviewed records, 11 patients (12 eyes; 14%) were identified as diabetics with endophthalmitis and were studied.

MAIN OUTCOME MEASURES

Stage of diabetic retinopathy, time to retinopathy progression, and visual acuity.

RESULTS

Mean patient age was 68 years, and mean duration of diabetes was 11.7 years. Mean patient follow-up was 17 months. Of the six cases without evidence of retinopathy before the endophthalmitis, none went on to develop retinopathy. Of six eyes with pre-existing nonproliferative retinopathy, four showed evidence of progression within 6 months of the infection. Three developed severe proliferative disease and macular edema, and one developed severe nonproliferative disease. More patients without pre-existing retinopathy achieved a final visual acuity of 20/40 or greater.

CONCLUSIONS

Patients with pre-existing diabetic retinopathy may be at increased risk for rapid retinopathy progression and a poorer visual outcome after endophthalmitis. These results support the concept that inflammation may exacerbate diabetic retinopathy.

Optic nerve sheath decompression for progressive central retinal vein occlusion

OBJECTIVE

To review our results with optic nerve sheath decompression (ONSD) for progressive central retinal vein occlusions (CRVO).

METHODS

Patients selected all had evidence of progressively worsening CRVO, a component of optic nerve swelling, and most were already monocular from prior disease in the contralateral eye. ONSD was performed using a nasal approach under retrobulbar anesthesia.

RESULTS

Eight eyes from 8 patients with a mean follow-up of 12 months were analyzed. Six patients improved, 2 worsened. Mean preoperative visual acuity was 20/160, and mean final postoperative visual acuity was 20/70. No complications occurred. Nonischemic CRVOs, patients < 65 years old, and those undergoing ONSD within 3 months of presentation seemed to do better.

CONCLUSION

ONSD may improve vision or stabilize visual loss in patients with progressive CRVO.

A case of ureteric obstruction, retroperitoneal fibrosis, and carcinoid tumour

We report the incidental finding at surgery for retroperitoneal fibrosis of a carcinoid tumour causing complete right ureteric obstruction. Retroperitoneal fibrosis is an uncommon inflammatory disease that leads to extensive fibrosis throughout the retroperitoneum. It can occur at any age, peak incidence being in patients between 40 and 60 years of age. Carcinoid tumours arise from enterochromaffin or amine precursor uptake and decarboxylation cells that occur in gastrointestinal tract. Carcinoid tumours are an uncommon clinical entity and incidence varies with gender and age. No association between retroperitoneal fibrosis and carcinoid tumour has been previously reported in the English literature, although one case has been reported in a French journal.

Methotrexate treatment for sarcoid-associated panuveitis

OBJECTIVE

To determine the safety and efficacy of low-dose methotrexate (MTX) for sarcoid-associated panuveitis.

DESIGN

Retrospective noncomparative case series.

PARTICIPANTS

Twenty eyes from 11 patients were analyzed. Eight patients had sarcoidosis. Three patients were clinically suspected of sarcoidosis despite negative laboratory testing. All charts of patients with sarcoidosis and idiopathic uveitis seen by the Duke Uveitis Service from 1989 to 1997 were retrospectively reviewed. Those with sarcoid-associated or sarcoid-suspected panuveitis treated with MTX with a minimum of 6 months of follow-up were studied.

INTERVENTION

Low-dose MTX was administered to patients weekly and patients were followed with serial ophthalmologic and medical examinations.

MAIN OUTCOME MEASURES

Visual acuity, oral and topical corticosteroid requirements, anterior chamber inflammation, and ability to undergo successful cataract extraction were used to measure the efficacy of MTX therapy.

RESULTS

After MTX treatment was initiated, 90% of eyes had preserved or improved visual acuity. Mean initial Snellen visual acuity was 20/62 and mean final acuity was 20/40 (P = 0.044). Of those patients initially requiring oral corticosteroids, the dosage was decreased in 100%, and they were completely discontinued in 86%. The mean initial oral corticosteroid dose was 26.6 mg and the mean final dose was 1.5 mg (P = 0.012). Topical corticosteroids were decreased in 63% of eyes. The mean initial use was once every 1.6 hours, and the mean final use was once every 3.9 hours (P = 0.001). Ninety-five percent of eyes had stabilized or decreased inflammation. The mean initial inflammation score was 1.2, and the mean final score was 0.5 (P = 0.007). Five of six eyes previously unable to have cataract extraction because of uncontrolled inflammation became quiet on MTX and underwent surgery. One hundred percent of these eyes had improved vision after surgery. Side effects were mild and transient or reversible.

CONCLUSION

Low-dose MTX is an effective and safe adjunct to treat chronic sarcoid-associated panuveitis.

Retinopathy progression and visual outcomes after phacoemulsification in patients with diabetes mellitus

PURPOSE

To determine the rate of progression of diabetic retinopathy following phacoemulsification surgery and to determine if surgeon experience and/or surgical duration adversely affect visual outcome.

METHODS

A retrospective review of 150 eyes of 119 diabetic patients who underwent phacoemulsification surgery over a 5-year period was performed. Data collected included patient age, sex, type and duration of diabetes, diabetic control, associated systemic health factors, preoperative visual acuity and retinopathy grade, duration of surgery, intraoperative complications, and postoperative course. The effect of these factors on visual outcome and rate of retinopathy progression was studied. Resident and private cases were compared.

RESULTS

The visual acuity improved by two or more lines in 117 eyes (78%). Ninety-three eyes (62%) had a final visual acuity greater than or equal to 20/40. Retinopathy progression was seen in 37 eyes (25%) followed up for 6 to 10 months. Preoperative nonproliferative diabetic retinopathy, prolonged surgical duration, and limited surgical experience were statistically associated with retinopathy progression.

CONCLUSIONS

The visual results and rate of retinopathy progression after phacoemulsification surgery in our series do not appear to differ significantly from those reported using other techniques. Nonproliferative diabetic retinopathy, longer surgical duration, and surgical inexperience resulted in an increased rate of retinopathy progression.

Rupture of the triceps muscle at its attachments

A case of rupture of the triceps muscle at both the origin and insertion is presented and no similar case has been reported in the literature, to the best of our knowledge.

Decrease in intraocular pressure after orbital decompression for thyroid orbitopathy

BACKGROUND

The effect of thyroid orbitopathy on intraocular pressure (IOP) remains controversial. We carried out a study to determine the effect of orbital decompression surgery on the IOP in patients with advanced thyroid orbitopathy.

METHODS

The records of 12 consecutive patients (22 eyes) who underwent decompression surgery for severe thyroid orbitopathy between 1985 and 1996 were reviewed. All patients were maintained on essentially the same medications before and after surgery. The IOP readings, obtained by means of applanation tonometry in primary gaze, from the pre- and postoperative visits were recorded, and the net change was calculated.

RESULTS

The mean preoperative and postoperative IOP values were 19.8 mm Hg and 16.8 mm Hg respectively, a significant difference (p = 0.008). Seven of eight eyes with an IOP of 21 mm Hg or greater preoperatively had a postoperative IOP less than 21 mm Hg; these eyes showed a mean decrease in IOP of 5.6 mm Hg. The degree of preoperative IOP elevation was found to be a strong predictor of the amount of IOP lowering after surgery (p = 0.014).

INTERPRETATION

Our results support the concept that orbital congestion associated with thyroid orbitopathy produces an increase in IOP by elevation of episcleral venous pressure (EVP) and that orbital decompression may reduce the IOP by decreasing EVP. Decompression surgery may obviate the need for more aggressive management of glaucoma in patients with severe thyroid orbitopathy.

Visual outcomes following lensectomy and vitrectomy for combined anterior and posterior persistent hyperplastic primary vitreous

OBJECTIVE

To determine the visual outcome after surgery for persistent hyperplastic primary vitreous using modern vitreoretinal techniques.

DESIGN

Retrospective medical record review during a 5-year period (June 1992 to June 1997). Information recorded for each patient included age, medical history, sex, results of preoperative ocular examination, age at diagnosis, procedure performed, intraoperative and postoperative complications, location and number of sclerotomy sites, type of aphakic rehabilitation, amblyopic therapy given, final visual acuity, and length of follow-up.

RESULTS

Fourteen patients who underwent surgical management of combined anterior and posterior persistent hyperplastic primary vitreous were identified. Eleven patients underwent aphakic rehabilitation and aggressive amblyopic therapy consisting of occlusive therapy for several waking hours each day. One additional older patient received aphakic rehabilitation only. Ten eyes (71%) achieved a visual acuity of 20/300 or better, and 8 (57%) obtained a final visual acuity of 20/100 or better. Average length of follow-up was 22 months (range, 4-57 months). Nine patients were fitted with an aphakic soft contact lens, 2 older patients had a posterior chamber intraocular lens placed at the time of vitrectomy, and 1 patient wore aphakic spectacles.

CONCLUSIONS

With modern vitreoretinal techniques, aphakic rehabilitation, and aggressive amblyopic therapy, useful vision can be obtained in the majority of patients with combined anterior and posterior persistent hyperplastic primary vitreous.

A comparison of the Marcus Gunn and alternating light tests for afferent pupillary defects

OBJECTIVE

The authors compared two methods, the Marcus Gunn test and the alternating light test, for detecting a relative afferent pupillary defect.

DESIGN

A randomized, prospective clinical trial.

PARTICIPANTS

Fourteen patients with unilateral optic neuropathy.

INTERVENTION

The Marcus Gunn and alternating light tests were performed on each patient.

MAIN OUTCOME MEASURES

The results of the Marcus Gunn and altemating light tests for detecting a relative afferent pupillary defect on the affected side.

RESULTS

The Marcus Gunn test was able to identify the affected eye in only 8 of 14 patients, whereas the alternating light test correctly identified the affected eye in 13 of 14 patients. Results of the Marcus Gunn test were indeterminate in 4 of 14 patients and were incorrect in 2 of 14 patients. Results of the alternating light test were indeterminate in one patient and never incorrectly identified the affected eye.

CONCLUSION

The alternating light test is superior to the Marcus Gunn test for detecting relative afferent pupillary defects.

Rate of vascularization of coralline hydroxyapatite spherical implants pretreated with saline/gentamicin, rTGF-beta 2, and autogenous plasma

Several authors have reported significant exposure rates using the hydroxyapatite orbital implant in the treatment of the anophthalmic socket. Histologic studies by ourselves and others have suggested that lack of fibrovascular ingrowth into the implants may contribute to conjunctival breakdown and exposure. Recently, much attention has been given to angiogenic factors, such as rTGF-beta 2 and those found in plasma, in accelerating wound healing and fibrovascular ingrowth. This pilot study compares the rate of vascularization of hydroxyapatite orbital implants pretreated with plasma, rTGF-beta 2, and a saline/gentamicin solution with that in untreated controls ina population of New Zealand albino rabbits. Hydroxyapatite orbital spheres were implanted subcutaneously and in enucleated orbits. Untreated implants were used as a control. Implants pretreated with plasma, rTGF-beta 2, and a saline/gentamicin solution were removed and examined histologically at weekly intervals for the first 3 weeks after implantation. Histologic studies demonstrated that the rate of vascularization significantly increased between 2 and 3 weeks postoperatively in all study groups. Pretreating the implants with rTGF-beta 2 in phosphate buffered solution (PBS) or autogenous plasma did not significantly increase the rate of vascularization in comparison with controls at weeks 1 and 2. However, pretreating the implants with a saline/gentamicin solution or PBS alone was associated with an increased rate of vascularization at weeks 2 and 3. No statistically significant difference in vascularization was noted between the subcutaneous and orbital implants at any week. Hydroxyapatite implants pretreated with saline/gentamicin or phosphate buffered solutions underwent more rapid vascularization at weeks 2 and 3 in comparison with controls. Additionally, all groups were noted to have a more rapid rate of ingrowth between weeks 2 and 3 than between weeks 1 and 2. Plasma and rTGF-beta 2 (at the dose used) did not significantly alter the rate of vascularization of hydroxyapatite implants during the first 2 to 3 weeks. The significance of these findings is discussed.

The use of topical aqueous suppressants in the prevention of postoperative intraocular pressure elevation following pars plana vitrectomy with long-acting gas tamponade

PURPOSE

To determine if topical aqueous suppressant therapy applied after pars plana vitrectomy (PPV) with gas tamponade successfully prevents postoperative elevation of intraocular pressure (IOP).

METHODS

A prospective, controlled study was performed on patients who met inclusion criteria and underwent PPV with gas tamponade (SF6 18%-20% or C3F8 12%-16%) over a 1-year period. Treatment eyes received topical aqueous suppressants at the end of surgery. Postoperative IOP checks were performed at 4 to 6 hours, 1 day, and 1 week.

RESULTS

Twenty-one control (C) and 20 treatment (T) eyes met the inclusion criteria. The IOP (in mm Hg) measured at 4 to 6 hours (23.05 [C], 14.73 [T] and 1 day (23.24 [C], 17.28 [T]) postoperatively showed a statistically significant difference between the groups (P = .0038) at 4 to 6 hours, and a trend toward significance (P = .057) at 1 day. Eleven control and 3 treatment eyes had an IOP spike above 25 mm Hg at 4 to 6 hours or 1 day postoperatively (P = .02), and 6 control and 1 treatment eye had a postoperative IOP above 30 mm Hg. A pressure rise above 40 mm Hg was seen in 2 control eyes and no treatment eyes.

CONCLUSIONS

Use of topical aqueous suppressants following PPV with long-acting gas tamponade is effective in preventing significant postoperative IOP elevation in a majority of cases.

Malakoplakia and colorectal adenocarcinoma

We report a case of malakoplakia in association with colonic adenocarcinoma. Tumour-associated malakoplakia in the gastrointestinal tract is a rare finding, generally confined to the colon. It may be locally aggressive, with invasion of pericolic tissues, but is always located adjacent to the tumour. This contrasts with the often more diffuse, multifocal distribution of colonic malakoplakia in association with other pathologies.

Recombinant hirudin prevents postoperative fibrin formation after experimental cataract surgery

PURPOSE

The authors studied the effect of a direct acting antithrombin agent, desulfatohirudin variant 1 (Revasc, Ciba-Geigy, Ltd., Basel, Switzerland), on postoperative fibrin formation after cataract surgery in rabbits.

METHODS

Phacoemulsification was performed in a masked fashion on 28 eyes of 28 New Zealand white rabbits. Ten control group eyes had lactated Ringer's solution in the infusion and an intracameral injection (approximately 1.5 ml) at the end of the case. Ten group 1 eyes received hirudin 100 micrograms/ml in the infusion and intracameral injection. Eight group 2 eyes had 100 micrograms/ml hirudin in the intracameral injection only. Using slit-lamp examination, all eyes were graded for the amount of fibrin and intraocular hemorrhage in a masked fashion on postoperative day 1.

RESULTS

Comparison of the mean postoperative fibrin grade (0-4) in group 1 (mean = 0.3), group 2 (mean = 0.25) and the control group (mean = 3.4) revealed a statistically significant difference between hirudin-treated and control eyes (P = 0.0002 for group 1, P = 0.0005 for group 2). No intraocular hemorrhage was noted in any group.

CONCLUSIONS

Recombinant hirudin significantly decreases postoperative fibrin formation in a rabbit cataract extraction model. Intracameral injection of hirudin alone appears to be at least as effective as infusion of hirudin throughout the case. With further study, this agent has potential for use in cataract surgery on patients known to be at high risk for postoperative fibrin formation.

Retinal vein occlusion after trabeculectomy with mitomycin C

PURPOSE

To evaluate acute retinal vein occlusion as a potential complication of trabeculectomy with mitomycin C in cases of advanced glaucoma.

METHODS

The records of three patients who developed retinal vein occlusions immediately after uncomplicated trabeculectomy with mitomycin C were reviewed.

RESULTS

All three patients had advanced open-angle glaucoma with total cupping of the optic nerve, severe visual field loss, and evidence of systemic vascular disease. A marked decrease in intraocular pressure was noted in the postoperative period in all of the patients.

CONCLUSION

A shift in the lamina cribrosa, associated with the perioperative intraocular pressure change, may have contributed to occlusion of the venous outflow system in these susceptible patients.

Fracture toughness ov conventional or photopolymerized glass ionomer/dentin interfaces

Several new light-cured glass-ionomer materials have been developed for restorative use. It is not yet clear, however, whether the ability of the conventional glass ionomers to bond chemically to dentin has been preserved in the new light-cured glass ionomers whose chemical compositions have been modified. The fracture toughness test was recently introduced as an appropriate method of measuring the fracture resistance of an interface. We have applied this test to the glass ionomer/dentin interface for the first time. Ten mini short-rod fracture-toughness specimens were fabricated for each group. Each specimen contained a chevron-shaped glass ionomer/dentin interface along its midplane. After 24 hours in 37 degrees C water, the specimens were tested by loading at 0.5 mm/min. The interfacial Kic results (MPa X m (1/2)) (SD), analyzed by ANOVA and Fisher's LSD test (P<0.05), were: Chem-fil II, 0.17 (0.04); Vitremer, 0.18 (0.15); Fuji II LC, 0.33 (0.16). There were no significant differences in interfacial Kic between the conventional and light-cured glass ionomers. Interfacial Kic's for a light-cured glass ionomer were, however, significantly higher when an intermediary dentin bonding agent was used. SEM examinations of the fractured surfaces indicated that crack propagation generally occurred along the bond interface, and indicated the formation of a resin-infiltrated layer when the dentin bonding agents were used. It was concluded that the fracture-toughness test could be a useful measure of the integrity of the glass ionomer/dentin interface. The clinical effect of an intermediary layer between the glass ionomer and the tooth structure is, however, unknown and requires further investigation.

Adult rabbit brain synthesizes retinoic acid

Tissues of adult rabbit brain were shown to enzymatically oxidize retinol and retinaldehyde to retinoic acid, a potent stimulator of gene expression. Rates of retinoic acid synthesis by the cerebrum, cerebellum, and meninges were comparable to, or exceeded, rates measured with rat liver, an organ known to have a relatively high capacity to synthesize retinoic acid. These results, taken together with previous observations that the adult brain contains retinoic acid-activated transcription factors and cellular retinoid-binding proteins, suggest that retinoids may play an important role in the adult central nervous system.

Synthesis of retinoic acid from retinol by cultured rabbit Müller cells

Previous observations have shown that Müller glial cells of the vertebrate retina contain cellular retinoid-binding proteins, that the retina contains retinoic acid, and that cellular retinoic acid-binding protein is present in amacrine neurons (and, in some species, Müller cells) within the retina. These findings led to the suggestion that Müller cells may synthesize retinoic acid and release it for use by other retinal cells. To test this possibility, we cultured Müller cells from adult rabbit retinas, incubated the cultures with radioactive retinol, and identified and quantified the resultant radioactive retinoids by HPLC. Retinaldehyde was rapidly synthesized from retinol, reaching a plateau of 1-2 pmol mg-1 cell protein by 30 min. Retinoic acid initially accumulated more slowly, but by 30 min constituted most of the synthesized retinoid. While the retinaldehyde remained within the cells, retinoic acid was rapidly released into the medium; extracellular retinoic acid exceeded the intracellular amount after 30 min of incubation. Smaller amounts of retinyl esters were also synthesized and retained by the cells. These results are consistent with the suggestion that Müller glia are a source of retinoic acid in the retina. The synthesis of retinoic acid by these cells, and the presence of retinal neurons that contain cellular retinoic acid-binding protein, raise the possibility that retinoic acid plays a role in the retina, although this role is not presently known. Furthermore, these results may have implications for other parts of the adult nervous system. Adult brain contains retinol- and retinoic acid-binding proteins, and, therefore, may also be a site of retinoic acid metabolism. Because of the relatively simple cellular organization of the retina and its demonstrated capacity to synthesize retinoic acid, the retina may be a system of choice for further studies of the synthesis and function of retinoic acid in adult neural tissue.